Menopause Symptoms: They’re Not Always Obvious

Hear the word menopause and, chances are, you’re ready to click off. Why? Cos it’s a condition that only affects women of a ‘certain age’ (read 50+), right? Well, not exactly. According to premature menopause charity The Daisy Network, premature menopause (or premature ovarian insufficiency as it is becoming increasingly known) affects 110,000 women aged 12-40, in the UK. That’s around one in every 1,000 women in their 30s and one in every 10,000 in their 20s – not including those women for whom the condition goes undiagnosed.

‘Menopause symptoms include lack of energy, reduced sex drive, anxiety and trouble sleeping – which can also be associated with other medical conditions or lifestyle factors,’ says women’s health doctor Daisy Mae, whose special interest is menopause. ‘Add to that the fact that many women take contraceptives which stop a monthly bleed, and that the menopause, on average, occurs around the age of 51, and it’s understandable why these signs may not immediately be associated by your GP to the menopause.’

But, with the long-term impacts of a misdiagnosis including a heightened risk of osteoporosis, heart disease and depression, it’s worth getting clued up on how to spot the signs of menopause yourself.

WHAT IS THE MENOPAUSE?

First up, what is the menopause? Quite simply, it’s when the ovaries can no longer produce the hormone oestrogen. Over a period of years or decades (the perimenopause), they gradually become less active and efficient until, eventually, they fail completely. After this point, no more eggs are produced and there are no more periods. This is what is used to describe women going through this change, who are over the age of 40.

Premature menopause or premature ovarian insufficiency (POI) relates to women below that age threshold. Although it carries many of the same menopause symptoms, a big difference is that the ovaries may not have failed completely – 5-10% of women with POI still conceive.

According to menopause expert Dr Louise Newman, the cause of premature menopause is largely unknown. ‘All women are born with a certain number of eggs – when these run out, our ovaries will stop working,’ she says. ‘However, certain women have an increased risk. Those who’ve got a family history of premature menopause; or have had a hysterectomy; or have an auto-immune condition such as diabetes, a thyroid disorder or coeliac disease.’

WHAT ARE MENOPAUSE SYMPTOMS?

‘As with any condition, menopause symptoms vary greatly from woman to woman,’ says Dr Newson. ‘As does how long they last. Some women may experience signs of the menopause for a few years; for others, they may last decades. The younger you are, or if you’ve had your ovaries removed, typically, the more severe they are.’

The common signs of menopause are:

Irregular periods or no bleed at all

Infertility

Hot flushes

Night sweats

Skin and hair changes such as drying or thinning

Breast tenderness

Vaginal dryness

Urinary infections

Reduced sex drive

Disrupted sleep

Lack of energy

Unexplained weight gain

Anxiety

Mood swings

Depression

‘Menopause can be determined by a blood test to measure your levels of Follicle Simulating Hormone (FSH) and oestrogen,’ says Dr Mae. ‘However, as hormone levels can fluctuate greatly, the test is best carried out in the first five days of your cycle or, if you are not having periods, two or three tests should be done, six weeks apart. FSH levels of 30 IU/ml indicate that the body is in a state of menopause.’

WHAT ARE THE RISKS OF PREMATURE MENOPAUSE?

Because oestrogen plays such a major role in women’s health from puberty, going without it for too long can lead to complications later in life – which is why early diagnosis of premature menopause symptoms, and HRT prescription, is so important.

OSTEOPOROSIS

‘You need oestrogen for strong bones,’ says Dr Mae. And Swedish research would agree, with results of a Skane University Hospital study finding that women who go through premature menopause are almost twice as likely to develop osteoporosis. ‘Bone thinning is silent. It often takes a fracture or break to identify the problem – by which point it can be too late to do anything about it.’

HEART DISEASE

According to research published by JAMA Cardiology, premature menopause increases a woman’s risk of coronary heart disease and death from cardiovascular disease. ‘Oestrogen relaxes the smooth muscles of blood vessels, so causes a reduction in blood pressure and helps to keep artery walls clear of emboli, clots or blockages, which can lead to strokes and heart attacks,’ says Dr Mae.

DEMENTIA

Turns out oestrogen is also responsible for keeping you quick-witted and sharp with research published in BJOG, revealing that women experience premature menopause have an increased risk of cognitive decline – not only in terms of recalling words and faces (40%) but also remembering how to control muscles responsible for movement (35%). It’s also been suggested that there is an increased risk of dementia.

DEPRESSION

Premature menopause has been linked to a heightened risk of depression by Greek researchers, who analysed 14 different studies, representing around 68,000 women. Why? It’s because oestrogen stimulates the feel-good neurotransmitter serotonin in your brain – so the less you have of the hormone, the lower your mood is likely to be. ‘Plus experiencing menopause symptoms – particularly when they’ve been undiagnosed – can be a very difficult and confusing time,’ says Dr Mae. ‘You can feel like you’re going mad.’

HOW CAN YOU TREAT THE PREMATURE MENOPAUSE?

To alleviate the symptoms of the menopause, and to reduce its long-term impacts the most common treatment is HRT – a therapy which replaces your body’s oestrogen levels with a chemically identical alternative. ‘It uses a natural oestrogen that your body has been producing since puberty,’ says Dr Mae. ‘This means your body won’t find it strange. And it’s given in a much lower dose to what your ovaries would have been releasing during a normal menstrual cycle. The oestrogen in a contraceptive pill is ten times more potent.’

HRT comes in many forms so it’s worth exploring your options and finding the best fit for you. For example, would you prefer a tablet, patch or gel? (FYI, Dr Mae believes the patch has a slight edge: ‘The hormones are directly absorbed through the skin, as opposed to passing through the mouth, stomach and liver.’) Which blend of oestrogens is closest to yours? And which progesterone? Unless you’ve had a hysterectomy, you’ll need an option that contains the two (known as combined HRT).

HRT is not a one-treatment-suits-all approach. Like going on the contraceptive pill, you might have to try a few before you find HRT.

‘We make up bespoke recipes in the menopause clinic,’ says Dr Mae. ‘So the product is personalised to the patient. A very common and popular regime we recommend, is for the woman to be fitted with a contraceptive Mirena coil – which ticks the progesterone box, as well as providing contraception, and typically stopping bleeding – and to then supplement this with an oestrogen.’

But what about the risks? Hasn’t HRT been linked to clots and breast cancer? Research around premature menopause is limited but, what has been shown says Dr Newson, is that women on HRT under the age of 50 are at no increased risk of breast cancer than if their ovaries were working normally. It’s only when you tip over that age bracket that the increase rises – by 0.2% over five years. ‘It’s important to weigh up any health risks with the benefits HRT has on your bone and cardiovascular health,’ says Mae.

CAN DIET HELP MANAGE MENOPAUSE SYMPTOMS?

Making slight changes to your diet may alleviate symptoms but should not be used as a complete alternative: ‘Balance is best,’ says Dr Newson. ‘Many women think they can simply eat lots of phytoestrogens but too many can create unopposed oestrogen in the body, which, if not balanced out by sufficient progestogen, can be linked to an increased risk of endometrial cancer.’

So what should you include in your balanced diet? Nutritional therapist and author of The Balance Plan: Six Steps to Optimise your Hormonal Health, Angelique Panagos, and natural menopause expert Maryon Stewart share their suggestions:

'The essential fats (omega 3 and 6) in raw nuts and seeds help keep cells softer and more elastic – great not only for your complexion but your sex life, too,’ says Panagos. ‘Snack on them, drizzle rapeseed oil on salads and top whole grain toast with organic eggs and smoked salmon.’

Or try this refuelling with this salmon frittata recipe.

'Take two tablespoons of ground golden flax seeds each day to normalise hormone function,’ says Stewart. ‘They contain a type of naturally occurring oestrogen called lignans.’ Stir them through smoothies and sprinkle over morning porridge.

‘The antioxidants in fruits and vegetables support the body through a hormonal change,’ says Panagos. ‘Add watercress or spinach to scrambled eggs and fill up on steamed broccoli.’ Why? These vegetables have the added bonus of being a source of calcium to support healthy bones. Try these spinach crisps.

‘Phytoestrogens can help balance hormones, reduce hot flushes and improve mood,’ says Panagos. ‘Soya, red clover and linseeds are some of the richest sources and they are also found in lentils, beans, chickpeas and fermented tofu.' Toss through stews and salads.

‘Studies on Femenessence Macapause, made from organic Peruvian Maca root, show it helps normalise the function of the hormone-producing glands in the body,’ says Stewart.

Dehydration can trigger a hot flush. ‘Try herbal teas, and avoid caffeine, alcohol and fizzy drinks, which are stimulants and can worsen hormonal imbalances and menopause symptoms,’ says Panagos.

WILL THE MENOPAUSE PUT STOP TO SEX?

Okay, so the menopause can reduce libido, and cause vaginal dryness and soreness. The urinary tract and vagina are full of oestrogen receptors, which need to be saturated to help them function. Without this hormone, the vagina and surrounding areas can become dry, thin and uncomfortable. ‘Seven in 10 women will suffer from this at some point in their lives,’ says Dr Newson. ‘The vagina needs to be elastic for all movement – so not only can friction during sex cause pain, but walking, exercising, sitting and even wearing underwear can be uncomfortable.’ But that doesn’t need to mean sex becomes a no-go area for the rest of your life.

One solution says Dr Mae, is a topical oestrogen treatment. ‘Use them nightly for two weeks, alternate nights for two weeks, then twice a week thereafter,’ she recommends. ‘Oestrogen delivered by a cream or pessary is localised so almost nothing is absorbed into circulation and they do not increase your risk of breast cancer.’

Another option, suggests Dr Newson is to moisturise and lube up. ‘Natural brands such as Yes and Sylk can be used every day or so, to ease dryness without irritating the lining of the vagina,’ she says.

Sources: The Daisy Network Support and information for women going through premature menopause; Menopause Matters Find your nearest specialist clinic; Women’s Health Concern The patient arm of The British Menopause Society; find out about events, research and contact the experts.